Diclofenac

Analgesic / Anti-inflammatory — NSAID

Nigerian brand names:VoltarenCataflamDicloflexEmzor DiclofenacFeloranDiclozip

Reviewed by the PMC Medical Team · Promise Medical Centre

Overview

Diclofenac is one of the most widely used non-steroidal anti-inflammatory drugs (NSAIDs) in Nigeria and globally. It relieves pain and reduces inflammation and is available in multiple formulations including tablets, injections, gels, and suppositories. It is particularly used in Nigerian clinical settings for musculoskeletal pain, post-operative pain, and acute injuries. Like all NSAIDs, diclofenac carries significant risks including gastrointestinal bleeding, kidney damage, and cardiovascular effects, and should be used at the lowest effective dose for the shortest necessary time. Among NSAIDs, diclofenac carries a slightly higher cardiovascular risk compared to ibuprofen or naproxen.

Uses

• Acute and chronic pain: musculoskeletal pain, back pain, neck pain, sprains and strains • Post-operative pain • Dental pain and tooth abscess • Menstrual pain (dysmenorrhoea) • Inflammatory conditions: rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout • Renal colic (kidney stone pain): diclofenac injection is highly effective • Eye inflammation: diclofenac eye drops for post-operative ocular inflammation and allergic conjunctivitis • Migraine attacks

How to Use

Adults: • Oral: 75–150 mg daily in 2–3 divided doses with meals; reduce to the lowest effective dose as soon as possible • Modified-release tablets: 75–100 mg once or twice daily • Injection: 75 mg deep intramuscular injection once or twice daily (usually only in hospital or clinic settings) • Gel: apply to the affected area 3–4 times daily IMPORTANT: • Always take oral diclofenac with food or milk to reduce stomach upset • Use the lowest effective dose for the shortest duration necessary • Do not exceed the prescribed dose • Diclofenac gel is generally safer than oral diclofenac for localised pain as systemic absorption is lower

Side Effects

Common: • Stomach pain, indigestion, nausea • Diarrhoea or constipation • Headache, dizziness • Injection site pain and muscle damage (with IM injection: a common cause of injection-site abscesses in Nigeria) Serious (stop and seek care): • Peptic ulcer or gastrointestinal bleeding: dark tarry stools, blood in vomit • Liver damage: jaundice, dark urine, right upper abdominal pain (diclofenac has higher hepatotoxicity risk than other NSAIDs) • Kidney damage: reduced urine output, swelling • Cardiovascular events: increased risk of heart attack and stroke, especially with prolonged high-dose use • Fluid retention and worsening of heart failure • Severe skin reactions (Stevens-Johnson syndrome: rare) • Severe allergic reaction

Warnings & Precautions

Do NOT use if you: • Have active or recurrent peptic ulcer • Have severe kidney disease • Have severe heart failure • Have established cardiovascular disease (higher risk than ibuprofen or naproxen) • Are in the third trimester of pregnancy • Are hypersensitive to diclofenac or any NSAID SPECIAL NIGERIAN WARNING — IM injection practices: • Diclofenac intramuscular injections are very commonly given in Nigeria for pain: often by untrained practitioners • IM diclofenac must be given deep into the upper outer quadrant of the buttock (not the thigh or upper arm) • Incorrect technique causes severe muscle damage (myonecrosis), injection abscesses, and sciatic nerve damage with lasting disability • If you need a diclofenac injection, insist on receiving it in a proper healthcare facility Do not take diclofenac for more than 5–7 days without medical review.

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Drug Interactions

• Aspirin and other NSAIDs: increased gastrointestinal bleeding: do not combine • Anticoagulants (warfarin): increased bleeding risk • Lithium: NSAIDs increase lithium levels: toxicity risk • Methotrexate: diclofenac reduces methotrexate excretion: increased toxicity risk • ACE inhibitors / ARBs / diuretics: increased risk of acute kidney injury (triple whammy) • Antihypertensives: NSAIDs reduce blood-pressure-lowering effect • Ciclosporin: increased nephrotoxicity risk • Antidiabetic drugs: may alter blood glucose levels

Storage

• Tablets: store at room temperature (below 25°C) away from moisture and light • Gel: store at room temperature; do not freeze; replace cap tightly after use • Suppositories: store in a cool, dry place or refrigerator as directed • Keep all forms out of reach of children

Buy only NAFDAC-registered medications

Nigeria has a significant problem with counterfeit and substandard drugs. Always purchase medications from a licensed pharmacy and check the NAFDAC registration number on the package — verify at nafdac.gov.ng.